Back pain guide
Welcome to Back pain guide
Your sore back is a nuisance, or worse. It may prevent you from doing what you need to do — for example, work — or what you want to do, such as enjoyable pastimes. You may have reached the point of wondering: "Will I be able to keep my mind off the nagging pain today? Will my back pain ever go away? When can I get better and become more active again?" If you're like millions of other people who deal with chronic nonspecific back pain, you're more than familiar with these questions.
Chronic nonspecific back pain is different from the occasional sore back you might have for a day or two after too much gardening or painting the ceiling. Unlike instances of acute back pain, chronic nonspecific back pain is:
- Long lasting. To be termed chronic, back pain usually has been present for three months at a time.
- Recurring. Even after resolution of one long episode of back pain, pain tends to return. However, the recurrence is highly variable among people and unpredictable.
Chronic nonspecific back pain is the kind of back pain that, by definition, is "nonspecific." In other words, in most cases the cause is unknown or difficult to pin down. If this kind of back pain describes your pain, then this decision guide is for you. If you need information about back pain that's associated with a herniated disk, especially back pain that involves radiating leg pain or leg muscle weakness, see this guide's "Related links" section for a link to another guide dedicated to that topic.
Think of you and your doctor as partners in managing and treating your chronic back pain. You'll want to carefully consider all your options and the risks and benefits of each in relation to your lifestyle and what's important to you. The information in this decision guide is intended to help you understand the various treatment options, from more-conservative to more-invasive techniques, and help you decide which treatment — or combination of treatments — is best for you.
Take about an hour to go through this information in sequence by following the links at the right or at the bottom of each page. This provides proper context and helps you understand more about chronic back pain, your treatment options, and the pros and cons to consider in making your decision.
Treatment options for back pain
Because chronic nonspecific back pain may result from several factors — physical, psychological and social — treatment often involves a multifaceted approach or an approach using multiple interventions.
Emphasis on improving function
The most important aspect of chronic nonspecific back pain is how it impacts your ability to function in your daily life. So, although it's important to reduce pain, the emphasis of the treatment isn't only on eliminating the pain, but on improving your ability to function as much as possible in your usual activities. As well as reducing pain and improving function, goals of treatment include giving you skills to self-manage your pain and avoiding adverse side effects of treatment.
Starting with a conservative approach
Treatment options include a variety of conservative approaches such as medications, exercise and physical therapy, and counseling, or they include more-aggressive approaches such as surgery. However, because nonspecific back pain often improves on its own or with conservative approaches, that's where you and your doctor will likely first focus your efforts. You'll likely reserve discussion of surgery or other more-invasive procedures for later consideration.
Noninvasive treatments for back pain
The goal of noninvasive treatment for back pain is twofold:
- Reduce but not necessarily eliminate your pain
- Help you improve your function so that you can resume as closely as possible your normal routine of work and leisure
After talking to you about the particular circumstances involving your back pain, your doctor may recommend one or more of the following common treatment options:
Back brace. Many back braces or corsets (lumbar supports) are available without a prescription at pharmacies and medical supply stories. Or, your doctor may prescribe a specific brace customized for your back. The rationale behind braces is that they may support your abdomen and take some of the load off your lower back, they may restrict motion, and they may improve posture. But there's also concern that use of braces may result in the wasting away (atrophy) of some muscles that support the spine through lack of use. If you use a brace, limit the use to intermittently several hours a day. If you have a labor-intensive job that places stress on your lower back, a back brace or corset can help you when you first return to work after a back injury by avoiding too much strain on your spine.
Back braces and corsets may also make transitional movements — such as from a sitting to a standing position — more comfortable during an episode of back pain. There's insufficient evidence that back braces are more effective at relieving back pain than no treatment at all. The best course of action may be strengthening your trunk muscles to be the primary support for your back.
Pain medications. You can take nonprescription medications, or your doctor may suggest prescription medications to relieve your discomfort until inflammation subsides and your body heals itself. Options include:
- Over-the-counter (OTC) analgesics. Analgesics are medications that relieve pain. They include nonsteroidal anti-inflammatory drugs (NSAIDs), counterirritants and topical analgesics. NSAIDs, such as aspirin, naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), can relieve pain and reduce inflammation. Another option is counterirritants, which you apply to your skin as a cream or spray. These nonprescription medications — which include Bengay, Icy Hot and capsaicin (Zostrix) — stimulate your sensory receptors of heat or cold to cover up or counter pain. Counterirritant products may temporarily relieve chronic pain. Topical analgesics, many of which contain salicylates — the main ingredient in aspirin — also can reduce inflammation. NSAIDs appear to provide some relief for acute back pain, but evidence is still lacking regarding effectiveness of NSAIDs in chronic low back pain. In addition, though NSAIDs are widely used for treatment of low back pain, long-term use can have side effects, particularly effects on the gastrointestinal system and the kidneys.
- Anticonvulsants. Low doses of drugs more commonly used in the treatment of seizures and epilepsy are sometimes used to help people who have low back pain in conjunction with leg pain. These medications include gabapentin (Neurontin), topiramate (Topamax), clonazepam (Klonopin), carbamazepine (Carbatrol, Tegretol) and valproate (Depacon). These drugs aren't usually useful in treating low back pain. Instead, they're sometimes directed at treating the leg pain component in people who primarily have back pain associated with leg pain.
-
Antidepressants. Some antidepressant medications, taken in lower doses than would be used to treat depression, may help in the treatment of low back pain. Antidepressants may work in a variety of ways. For example, they may result in a higher level in your brain of serotonin, a neurotransmitter associated with pain control. Antidepressants may also reduce anxiety and muscle tension.
The evidence on the effectiveness of antidepressant medications in the treatment of low back pain is mixed. Among this group of medications, tricyclic antidepressants (TCAs) appear to be the most effective. They include such medications as nortriptyline (Aventyl, Pamelor), amitriptyline, desipramine (Norpramin), doxepin (Sinequan) and imipramine (Tofranil). Medications called selective serotonin reuptake inhibitors (SSRIs) don't appear to be as effective as TCAs for back pain.
- Opioids. In select cases, doctors may use certain narcotic medications (opioid analgesics) to treat low back pain. Examples of these medications include morphine (MS Contin, Oramorph SR, others), oxycodone (OxyContin), methadone (Dolophine HCL), fentanyl (Duragesic) and levorphanol (Levo-Dromoran). There is debate regarding the use of opioids, and they're not used as a long-term treatment. Among the reasons are side effects, as well as concerns about dependence. The most common side effects that limit their use include nausea and constipation, which can be severe. In addition, other common but less known important side effects include dizziness and sedation. Before your doctor prescribes opioids, have a thorough discussion with him or her about their benefits and drawbacks.
Cold or heat therapy. Using cold and heat therapy may relieve pain and muscle tension in the initial days after back pain begins. Some studies show that heat is an effective approach for acute nonspecific back pain. As for chronic back pain, cold and heat likely won't cause harm and may be helpful, but there isn't scientific evidence at this time to prove that cold and heat are effective treatments for chronic low back pain. Cold or ice applied to your back can reduce inflammation and swelling by constricting blood vessels. The cold also acts to slow nerve impulses and make it less likely that your muscles will contract, in this way reducing pain.
To use cold packs, wrap an ice pack or a bag of frozen vegetables in a piece of cloth. Hold it on the sore area for about 15 minutes, several times a day. To avoid frostbite, don't place ice directly on your skin. Heat therapy increases blood circulation, which can aid healing of damaged tissues. Heat also allows tissues to stretch more easily, resulting in less stiffness, greater flexibility and less pain. To use heat therapy, take a warm bath, or use warm packs, a heating pad or a heat lamp for pain relief. Be careful not to burn your skin with extreme heat. If you find that cold provides more relief than heat, you can continue using cold packs, or try a combination of the two methods.
Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it may stimulate release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses. However, it's unclear whether those who benefit from TENS achieve relief by some direct effect on their nervous system or from the belief that they will benefit from the therapy (the so-called placebo effect). Some people with chronic pain use TENS to help them function with less discomfort. But several studies have concluded that TENS has not been proved effective in relieving chronic low back pain.
Exercise and physical therapy. Physical activity plays a strong role in recovering from back pain and particularly in helping to prevent future pain and loss of function. Physical activity can include one or many among a wide range of exercises that you do in the presence of a physical therapist, or exercises that you do on your own at home. An exercise program can include any or all of the following components: flexing, stretching, endurance training, strength building and aerobic.
Supervised programs that include stretching and strengthening exercises, which don't specifically target the back, are more beneficial in relieving chronic low back pain and improving function. Your doctor or physical therapist can tailor an exercise program to meet your individual needs. There is no one-size-fits-all approach. Exercise programs are individualized because people have different levels of pain and differing injuries that caused the pain initially.
Exercise doesn't appear to increase your risk of future back injuries and may help prevent back pain at work. Benefits of a physical activity program may include:
- Pain reduction
- Strengthening of weak muscles
- Stretching of contracted muscles
- Decreasing mechanical stress on your back
- Improving your fitness to prevent injury
- Stabilizing your back
- Improving your posture
- Improving your mobility
- Decreasing the rate and severity of recurring back pain
- Allowing quicker recovery from future flares of back pain
Some studies suggest that exercise therapy is more effective than are conservative or inactive treatments in people with chronic low back pain. Short-term, modest improvements were seen in such areas as pain, disability, strength and flexibility. Exercise and physical therapy are an important part of your treatment program and should become part of your permanent routine at home. Improving the strength, endurance and function of your back helps minimize the chance of recurrence of back pain. One study showed that people who didn't exercise after an initial episode of acute low back pain were more likely to experience a recurrence of low back pain than were people in the study's exercise group. Mild discomfort that you may feel as you begin an exercise program should gradually ease as your muscles become stronger. The key is to start an exercise program at a low level to ensure your comfort and proper technique, and then progress slowly as your symptoms allow.
Cognitive behavior therapy. This type of talk therapy combines attempts to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts determine how you behave. Even if an unwanted situation hasn't changed, you can change the way you think and behave in a positive way. The therapy may have a role in the case of chronic low back pain for which no specific physical cause is evident.
Your doctor may talk to you about the psychological and social issues surrounding your chronic pain, such as whether you have stress, anxiety or depression, how your family has responded, how the pain has affected your work and other activities, and what you believe causes the pain to continue. You and your doctor may also talk about your readiness to accept that the condition will improve over time without any major medical intervention. Cognitive behavior therapy has been shown to be effective in relieving pain and improving function as one component of back care.
Multidisciplinary treatment programs. A multidisciplinary approach to treating chronic low back pain involves, as the phrase suggests, a variety of therapies. These may include a combination of exercise, physical therapy, education, cognitive behavior therapy, vocational counseling and other strategies. Reviews of studies show long-term effectiveness of multidisciplinary treatment programs in lowering pain, improving function and reducing return to work time.
Noninvasive treatments for back pain: Pros and cons
Nonsurgical, noninvasive approaches are likely to be what you'll begin with. Low back pain often improves on its own over time or with the help of conservative approaches. People with acute low back pain generally experience substantial improvement in the first month after initially seeing their doctor. When it's time to decide on nonsurgical, conservative approaches, consider these points:
| Pros | Cons |
|---|---|
| Conservative approaches are less invasive than surgery and don't require the recovery time that surgery does. | You may have to be patient. It may take a while for you to return to your desired level of activity at work and at leisure. |
| Conservative approaches allow your body's own natural healing process to work, which is what happens most of the time with back pain. | If you take pain medications, they may cause side effects. |
| You can try conservative approaches and always opt for a more-aggressive approach later. | Conservative approaches may require a change in habits, such as regular exercise to strengthen your back. |
| Other than your pain, your doctor may not have any physical findings on which to recommend surgery. | If your pain is severe, persistent and disabling, you may struggle with feelings to move to a more-aggressive approach. |
| Conservative approaches cost less than surgery. | |
| You avoid the risks of surgery. |
Invasive treatments for back pain
Treatment for most people with chronic nonspecific back pain is with a conservative multidisciplinary approach that may include exercise and physical therapy, medications and other methods. Surgery and other invasive approaches remain an option if less conservative approaches are ineffective. Even if magnetic resonance imaging or another diagnostic imaging technique doesn't show a potential source of pain in your vertebral joints or disks, but your pain appears to be originating in those locations, you and your doctor may consider a more-aggressive approach to remove or reduce the pain and improve your function.
Spinal fusion
If the cause of your back pain seems to be motion between segments of your vertebrae, spinal fusion may be a way to prevent motion and stop the pain. Spinal fusion involves permanently connecting — or "welding" — two or more vertebrae together.
Spinal fusion was formerly used primarily for conditions such as scoliosis and other spinal deformities. Today, although most people with chronic low back pain don't need to undergo spinal fusion, it has become increasingly popular for treating low back pain. The number of spinal fusions for all causes in the United States has more than doubled since 1993. Spinal fusion has been used as a treatment for what's called discogenic pain — pain originating in the area of a particular disk and without involving leg pain (sciatica).
Evaluating your suitability
Before you and your doctor agree to surgery as an option, your doctor will want to make sure that you've given nonsurgical treatments a reasonable trial. Also, your doctor may conduct a study called a diskogram, which is a special X-ray examination that involves the use of a dye. The dye, injected into a disk, serves to make it appear better on an X-ray. The injection of dye may also produce a pain similar to your ongoing back pain, which helps your doctor pinpoint that disk as the source of your pain.
What to expect during the procedure
Spinal fusion surgery requires general anesthesia. The procedure may take from two to 12 hours, depending on how extensive the surgery is and the technique your surgeon uses. Surgery may involve a large incision, or may be done using newer techniques with smaller incisions.
To fuse the spine, your doctor needs small pieces of extra bone to fill the space between two vertebrae. This bone may come from your own body (autogenous bone), usually from a pelvic bone. Or, it may come from another person (allograft bone) by way of a bone bank. If the front of your spine is fused, the disk is removed first. Bone graft substitutes, such as genetically engineered proteins, are being developed as alternatives to using bones from your body or a bone bank. Sometimes, doctors also use wires, rods, screws, metal cages or plates. As with any surgery, spinal fusion carries risks, including pain at the donor site for the bone, infection and nerve injury.
The aftermath of surgery
Expect to be in the hospital for several days after surgery. You'll also likely experience considerable pain and discomfort after surgery, but your doctor will control pain with oral and intravenous medications. It takes from several weeks to several months to heal from this surgery, depending on your age, condition and what level of activity you plan to return to. The type of healing that needs to occur after spinal fusion is comparable to recovery from a broken bone. The earliest that X-rays might reveal bone healing after spinal fusion is about six weeks.
Spinal fusion removes some spinal flexibility. This can be beneficial if movement and instability between spinal segments is what causes your pain. However, the fused spine needs to be kept in proper alignment. You'll be taught how to move, sit, stand and walk in a manner that keeps your spine properly aligned. You may be able to start a physical rehabilitation program as early as about four weeks after spinal fusion surgery.
Set realistic expectations
Beyond the immediate potential risks of spinal fusion surgery, the areas of your spine adjacent to the fusion will bear more stress. This makes those areas more likely to experience future wear and tear. That may mean you'll need to undergo surgery again. About 20 percent of people who have spinal fusion surgery need another operation within 11 years.
Also, like any treatment for back pain, don't expect spinal fusion to eliminate your pain — just to improve it. For example, if your level of pain on a scale of 0 to 10 was a 7 before surgery, your doctor might regard a reduction to a pain level of 3 or 4 to be a successful result.
More study is needed regarding the long-term efficacy of spinal fusion to treat discogenic pain. A study published in the May 2005 issue of the British Medical Journal concluded that people who are candidates for spinal fusion may obtain benefits similar to those of surgery from an intensive rehabilitation program. A 2007 systematic review of several studies, including the 2005 British Medical Journal study, stated it wasn't possible to reach a definitive conclusion about whether fusion surgery might be effective in treating discogenic pain. The review did state that the nature of nonsurgical treatment of back pain "may be critical" in determining whether it's a better approach than fusion.
A 2004 opinion article in the New England Journal of Medicine stated that "the emphasis of research efforts should shift from examining how to perform fusion to examining who should undergo fusion. The indications for this invasive and expensive procedure remain unclear despite its rapidly expanding use." A 2007 article in the New England Journal of Medicine addressed the issue of who needs back surgery, and concluded that for people with major disability or major spine trauma, surgery "may preserve life or function." However, "absent major neurologic deficits, patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, but the appropriate surgical procedures may provide valuable pain relief."
At the time you and your doctor discuss whether you're a good candidate for spinal fusion, he or she may mention a newer option — disk replacement therapy. The Food and Drug Administration approved this therapy in 2004. However, it's still too early to know the long-term outcome of disk replacement therapy.
Other invasive treatments for back pain
The effectiveness of these other invasive approaches to treating chronic nonspecific low back pain is mixed or unclear.
Radiofrequency neurotomy. This approach, also called radiofrequency lesioning, involves applying heat to certain nerve pathways to block the transmission of pain. To begin the procedure, usually done on an outpatient basis, an area of your skin is numbed. Then your doctor inserts a radiofrequency needle into the area in which he or she wants to block the pain. Your doctor uses a special X-ray machine (fluoroscope) to guide the needle into the precise location. Once your doctor positions the needle, a small electrode is inserted through the needle. To confirm the correct location, your doctor asks if you feel a tingling sensation. An electrical current is then passed through the electrode, heating up and damaging nerve fibers and creating an area of injury (lesion).
Radiofrequency neurotomy isn't a permanent procedure, however. Your nerves will try to grow back, and pain may return in as soon as six months. Short-term side effects may include a burning sensation, pain, numbness and a slight loss of muscle strength. So far, there's conflicting evidence of the effectiveness of the procedure in relieving low back pain originating from the facet joints. And there's limited evidence regarding the effectiveness of relieving pain originating from the disks. Because the evidence is inconclusive, more study is necessary.
Interventional therapy. This treatment refers to injection of anesthetics, steroids or narcotics into soft tissues, joints and other areas in and around your spine. The purpose of such injections is to block nerve conduction, relieving pain. The injection can be in the form of an epidural block, which means the medication is injected into the epidural space (near the spinal cord, but not in the cerebrospinal fluid). Or, the injection may be into a facet joint, which is a joint between two adjacent vertebrae. In some cases, the injection is into the sacroiliac joint, which connects the bottom of the spine with the hip, or into a trigger point, which is a painful knot in a muscle. Reviews of studies have found conflicting evidence regarding the effectiveness of epidural steroid injections in relieving pain in people with chronic low back pain. Studies also haven't shown the effectiveness of facet joint injections in relieving pain in people with chronic low back pain at various intervals of time from the injections.
IDET. Intradiscal electrothermal therapy (IDET), or annuloplasty, is a treatment procedure that involves applying heat to the annulus, the ring of fibrous tissue that surrounds the jelly-like nucleus of the disk. The goal of the procedure is to relieve pain coming from the disk itself. While once a popular treatment option, IDET has fallen out of favor as studies have shown no benefit over placebos.
Invasive treatments for back pain: Pros and cons
You and your doctor may discuss a surgical or other invasive approach if conservative approaches haven't appeared to relieve your low back pain or improve your function. Your preferences, concerns and lifestyle play a large role in determining the best choice about these more-aggressive approaches. Before deciding on surgery or another invasive procedure, consider these points:
| Pros | Cons |
|---|---|
| Invasive procedures to damage nerve endings can sometimes effectively block pain when other methods have failed. | Procedures that block pain may not be permanent; you may need the procedure repeated. |
| Invasive procedures may lessen pain considerably and allow you to fully participate in an active rehabilitation program. | Surgery and other invasive procedures don't always work. Some people have good results; some show little change; some may even experience more pain. |
| Spinal fusion can stop the motion and instability in your back that cause pain. | Spinal fusion removes some of the flexibility of your spine. This means learning some adjustments in how you move after surgery. |
| A more-aggressive approach may make it possible for you to resume work and other activities that are important to you, and more quickly than a less aggressive approach. | Surgery involves recovery time, and it can have side effects; for example, some people experience later degeneration in the area adjacent to the spinal fusion surgery. |
| Long-term outcomes may be as good with less invasive procedures, and less costly. |
Complementary and alternative therapies for back pain
Americans commonly use complementary and alternative approaches to conventional care for low back pain. Complementary generally refers to treatments that you might choose in addition to conventional medical treatment. Alternative generally refers to treatment that you might choose in place of conventional treatment.
Consider these approaches as possible tools to help you with pain relief and comfort. An approach such as exercise therapy is really what helps make your tissues healthier and stronger. So even though the following passive therapies have their place, it's better to take as active a role as you can in helping yourself get better. Here are some of the most common complementary and alternative approaches that people use for low back pain:
- Spinal manipulation. This treatment involves your health practitioner using his or her hands to apply sudden force to the joints in your back. In the United States, spinal manipulation is most commonly performed by chiropractors, but the technique is also used by osteopathic physicians, sports medicine doctors, physical therapists and others to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation is a low-risk procedure that may provide increased mobility and emotional and psychological benefits. Some studies report moderate to good evidence for the effectiveness of spinal manipulation for low back pain, but most positive results were in people who did not have long-lasting symptoms.
- Acupuncture. In this treatment approach, an acupuncturist inserts hair-thin needles under your skin, causing little or no pain. The needles usually stay in for 15 to 30 minutes. You may need several sessions. Pain relief may come from the release of endorphins, your body's natural painkillers, but how this method works isn't known for sure. A review of several studies on the use of acupuncture in people with chronic low back pain showed that acupuncture provides definite pain relief in the short term and perhaps over the long term.
- Massage. Massage therapy is done by a therapist using fingers and hands to manipulate the soft tissues of the body — muscles, skin and tendons. Massage can relieve muscle tension and stress, promote relaxation, and improve circulation and range of motion. Massage therapy generally is safe and doesn't have adverse side effects, but it's not completely risk-free. Massage isn't advisable for people with unhealed fractures, deep vein thrombosis, skin infections or open wounds, rheumatoid arthritis in the area to be massaged, or severe osteoporosis. Some studies have found moderate to strong evidence of positive benefits of massage in treating chronic low back pain.
-
Biofeedback. Chronic pain may be associated with a range of physical, social and psychological components. Although you may have taken effective steps to eliminate or reduce the physical causes of your pain, these may not have been enough to address any associated changes in your personality or mental health. An approach such as biofeedback helps address your state of mind and can help you relax muscles.
In a biofeedback session, a trained therapist applies electrodes and other sensors to your body. The electrodes are attached to devices that monitor and give you feedback on such items as muscle tension, brain wave activity, respiration, heart rate, blood pressure and temperature. Once the electrodes are in place, your therapist uses relaxation techniques to calm you, reducing muscle tension and slowing your heart rate and breathing.
You then learn how to produce these changes yourself. The goal is to help you enter a relaxed state in which you can better cope with your pain. Reviews of studies on the use of biofeedback in people with chronic low back pain show conflicting evidence regarding its effectiveness.
- Traction. Traction involves using weights, harnesses or gravity to apply a constant or an intermittent longitudinal force along the length of your spine. The goal is to stretch your muscles, ligaments and other parts of your spine to try to better align your back and to reduce pressure on your disks. Although some people with pain in the upper part of the back may see some benefit with traction, there's little evidence that traction helps with chronic low back pain.
- Ultrasound. This form of therapy delivers deep heat by using high-frequency sound waves. In the treatment, your therapist first applies a conductive gel to your skin. Then, using a hand-held probe attached to an ultrasound machine, ultrasound vibrations are transmitted through your skin to deeper tissues. Among the reported benefits are reduced stiffness and reduced muscle spasm, and decreased pain. Evidence is limited on the effectiveness of ultrasound in treating chronic low back pain.
-
Yoga. Yoga involves the use of physical poses and controlled breathing to achieve a calm mind and relaxed body and to improve physical fitness. Yoga can help relieve stress. Its quiet, precise movements focus your mind on the moment as you move your body through poses that require balance and concentration. Yoga, which originates from the Hindu religion, is usually taught by instructors in class settings. A study of adults with chronic low back pain found that a gentle yoga routine was as effective as pain medication in reducing pain, and that the benefits lasted for several months.
Note that some yoga positions can be strenuous and difficult to master, and may produce back strain. Care should be taken in selecting a trained yoga instructor who can help you select the proper poses for you.
Emerging therapies for back pain
Research continues into therapies that may effectively treat chronic low back pain and that may eliminate drawbacks of some of the current treatment methods. Here's one therapy that's receiving a lot of attention:
Disk replacement therapy
This method may be an alternative to spinal fusion that may be able to reduce pain without limiting the flexibility of your spine. In this approach, your surgeon uses a device to replace all or part of a damaged or collapsed disk that is the source of your low back pain. The replacement disk may be made of metal or plastic or a combination of the two materials.
By replacing a disk, the proper height of the disk is restored, as is the proper spacing between the adjacent vertebrae. The procedure may result in pain reduction by relieving nerve compression, allowing greater range of back motion and a higher level of functioning. Disk replacement has gathered attention in part because of some of the drawbacks of spinal fusion, which include less mobility and the possibility of degeneration of areas around the fusion. Some early studies have shown that results of disk replacement therapy compare favorably to those of fusion. But it's still too early to know the long-term outcomes of this procedure.
Other emerging therapies
Other therapies in the exploratory phase as a way of preserving back motion, relieving pain or being less invasive than either spinal fusion or disk replacement include:
- Dynamic stabilization. This surgical process uses flexible materials to stabilize an unstable segment of the spine without actually fusing one segment of the spine to another. This preserves greater motion.
- Biological solutions. This approach involves development of biological proteins, such as bone morphogenetic protein (BMP), that can help stimulate bone growth. This could make surgical procedures such as spinal fusion more effective.
- Gene therapy. Gene therapy involves the transfer of genetic material into target cells, such as those of a spinal disk. This procedure holds great promise as a new tool in the future treatment of disk regeneration.
Watchful waiting for back pain
Back pain is among the most common of medical complaints. But just because you have back pain doesn't necessarily mean you need medical attention. And if you do need medical attention, it doesn't necessarily mean that you need an invasive treatment to make you feel better.
Watchful waiting as an approach to dealing with low back pain doesn't mean that if you have back pain you simply do nothing and see what happens. What it may mean, though, is that if you have acute back pain, you give the pain a chance to improve with conservative, self-care approaches. And even if you have chronic back pain, you see what active, self-care steps you can take on your own before assuming that you need a more aggressive, invasive approach. Most people are able to deal with low-level, nagging or even annoying back pain using self-care, adjustments and other coping skills. You may not need any higher level of treatment unless your pain interferes with your work, your leisure or your sleep.
Watchful waiting may not be the best option if you have "red flag" indications associated with your chronic low back pain. Your doctor can explain what these may be, but they may include: advanced age, disability, history of cancer, trauma, prolonged use of corticosteroids and osteoporosis, and other factors.
Things to consider about back pain treatment
Both a noninvasive, nonsurgical approach and a surgical or other more-invasive approach can be appropriate treatment for chronic low back pain. It's possible that either approach will lead both to reduced or eliminated pain, and — just as important — to a higher level of functioning than you've been experiencing with your back pain. However, a noninvasive, nonsurgical approach is the far more frequent course of action. Which approach is best depends a lot on your specific diagnosis, personal situation, how much pain you're in, how long you've been in pain, your feeling about your pain, and work and lifestyle factors.
Whichever approach you opt for, it's understandable that you want to deal with your pain and move forward. You'll want to discuss fully with your doctor your personal situation, whether noninvasive approaches you may have been following are heading in the right direction, or whether you're a suitable candidate for a more-invasive approach. You'll also want your doctor to carefully explain more-invasive approaches so that you understand exactly what's involved in the procedure and what to expect afterward.
Many treatments and devices available for low back pain are unproved. Ask your doctor about any products that you're unsure of before spending money on them.
Here are some questions to consider as you and your doctor discuss your treatment options:
What's your current level of pain? Is your pain slight or moderate, or are you in severe pain? Are you in pain all of the time, or does your back pain come and go? And even more important than having some level of pain, how has low back pain affected your ability to function at work, at home and in your leisure activities?
Have you given noninvasive, nonsurgical treatments a fair chance? How long have you had low back pain? How much of a recurring problem is it? Have you tried an array of noninvasive treatments, and what kind of effect have these approaches had? Have you given enough time for these noninvasive treatments to work?
Is surgery a good option for you? Do you have some sort of degeneration or instability that surgery can address? Even if you do, is it of such a nature and severity that it's time for surgery? After all, some degeneration in the back is common by middle age — and most people continue to work with conservative approaches to improve their function and reduce their pain.
What's the likely effect on your lifestyle depending on which option you choose? If you avoid a more-aggressive approach, are you able to control your pain so that you can function the way you need to and want to most of the time? If you do take a more-aggressive approach, are you prepared for the weeks of recovery that may be involved and for adjustments in how you sit, stand, walk and move, in the case of spinal fusion?
Is your doctor's experience and training having undue influence on your treatment decision? Make sure you and your doctor decide on the treatment that's right for you, not just the treatment that your doctor is trained in or has the most experience with.
Some additional thoughts
Remember, whichever approach you take, there's a chance that you'll benefit markedly from that approach but also a chance that you'll be dealing with additional low back pain. And the approach you take requires commitment on your part. A noninvasive, nonsurgical approach demands careful attention to strengthening your back and being aware of situations or poor mechanics that may injure your back in the future. A more-invasive approach requires you to make adjustments after your therapy, and you may face additional treatment in the future.
